International journal of surgery
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Postoperative delirium is a common and serious adverse event in the elderly patient and is associated with significant morbidity and mortality. It is of great importance to identify patients at risk for delirium, in order to focus preventive strategies. The aim of this article is to systematically review current available literature on pre-operative risk factors for delirium after vascular surgery. ⋯ Delirium is a common complication after elective vascular surgery in elderly. The highest delirium incidence was observed after open aortic surgery as well as after surgery for critical limb ischemia. A picture starts to form of which predisposing factors lead to increased risk of delirium. The leading risk factors consistently identified in this systematic review were advanced age and cognitive impairment. Multi-disciplinary specialist-led interventions in the preoperative phase could decrease incidence and severity of delirium and should be focused on identified high-risk patients.
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Surgical trainees are expected to demonstrate academic achievement in order to obtain their certificate of completion of training (CCT). These standards are set by the Joint Committee on Surgical Training (JCST) and specialty advisory committees (SAC). The standards are not equivalent across all surgical specialties and recognise different achievements as evidence. They do not recognise changes in models of research and focus on outcomes rather than process. The Association of Surgeons in Training (ASiT) and National Research Collaborative (NRC) set out to develop progressive, consistent and flexible evidence set for academic requirements at CCT. ⋯ This approach has engaged stakeholders to produce a progressive set of academic requirements for CCT, which are applicable across surgical specialties. Flexibility in requirements whilst retaining a high standard of evidence is desirable.
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Although angioembolization increases the success rate of non-operative management in patients with blunt splenic injuries (BSI), the issue of contrast-induced nephropathy (CIN) due to serial administration of contrast medium remains unclear. We aimed to examine the risk factors of CIN and their clinical effect on mortality in patients with BSI. ⋯ In this study, we found that BMI ≥ 30 kg/m2, ISS ≥ 25, and 24-h Hb < 10 g/dL were independent risk factors for the occurrence of CIN in patients with BSI. However, angioembolization was not identified to be an independent risk factor for CIN. In addition, CIN and diabetes mellitus were identified as independent risk factors for mortality in patients with BSI.
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Review Meta Analysis
Meta-analysis of randomized controlled trials on the efficacy and safety of ondansetron in preventing postanesthesia shivering.
Considerable controversy exists regarding the efficacy of ondansetron in preventing postanesthesia shivering (PAS). We performed a meta-analysis of randomized controlled trials to examine the controversy. ⋯ Treat with ondansetron is safe, and may reduce PAS. This finding encourages the use of ondansetron to prevent PAS, but, more high quality randomized clinical trials are still warranted to confirm the effects of different doses of ondansetron on PAS.
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Review Meta Analysis
Cannulated screw fixation and plate fixation for displaced intra-articular calcaneus fracture: A meta-analysis of randomized controlled trials.
Displaced intra-articular calcaneus fractures (DIACFs) are the most common type of calcaneus fracture. The differences in therapeutic effectiveness between cannulated screw fixation (CSF) and plate fixation are still unclear. Thus, in this meta-analysis, we evaluated the therapeutic effectiveness of these two fixation methods. ⋯ Cannulated screw fixation and plate fixation have similar fixation effectiveness and functional outcomes in the treatment of displaced intra-articular calcaneus fractures. Due to the shorter duration of surgery and low rate of complications, cannulated screw fixation is superior to plate fixation. However, further studies are needed to evaluate cannulated screw fixation for various Sanders types of calcaneus fractures.